OFG Flashcards
(25 cards)
What is OFG
- clinical presentation of oedema in the oral and facial soft tissues by blockage of lymphatic drainage due to immune reaction
How does angio-oedema present
- appears quicklu
- settles quickly
What is angio-oedema due to
- increased fluid exudate from capillaries, due to increased vascular permeability
- no lymphatic drainage as level of fluid overwhelms lymphatic system
Why does angio-oedema settle quickly
24-48 hours needed for lymphatic system to drain that fluid exudate
lymphatic drainage is normal
Why does OFG settle slowly
lymphatic drainage is blocked by granulomas
can take weeks and months to settle with fluctuating swelling
Why is OFG considered a provisional diagnosis
- only OFG when no cause identified
- causes of ‘OFG’ are sarcoidosis, tuberculosis and crohn’s
What is sarcoidosis
- formation of granuloma present
- lungs usually effected
- oral presentation uncommon
What is tuberculosis
- bacterial infection
- formation of granulomas
- oral presentation uncommon
What is crohn’s
- formation of granulomas
- type of inflammatory bowel disease
What type of hypersensitivity reaction is angio-oedema
- type 1
What is type 1 hypersensitivity reaction
- degranulation of mast cells in response to an allergen which causes vasoactive compounds to be released
- act upon local vessels to increase permeability and fluid exudate
What type of hypersensitivity reaction is OFG
type 4
What is a type 4 hypersensitivity reaction
- delayed hypersensitivity
- t cells are activated by an allergen
- trigger macrophage activity which try to phagocytose the allergen
- eventually form multinucleate giant cells due to their struggle phagocytosing
What is the presentation of OFG
- any age - childhood/adolscent most common
- often presents at low level where px is unaware
- most cases are mild
- severe and unremitting OFG can be extremely disabling for px
What are the clinical features of OFG
- lip swelling and fissuring
- angular cheilitis
- cobblestoning
- gingivitis (not plaque related)
- ulceration
- microscopic granuloma
- erythema
How does the ulceration in OFG present
- linear ulcer at depth of sulcus
- filled with granuloma
What screening is done for crohns based on OFG
- make px aware to look out for altered bowel habits and abdominal pain
- monitor growth - should follow one defined centile line. moving from line to line indicates nutritional and GI problem
- faecal calprotectin test
What does the faecal calprotectin test represent
- good marker for inflammatory bowel changes
- unreliable in <7YO
- can be used for screening for endoscopy
What is the initial management for OFG
reach definitive diagnosis
* rule out crohn’s
diet history
* exclusion diet
What are the common dietary triggers for OFG
- fizzy drinks
- benzoic acid
- sorbic acid
- cinammon products
- chocolate
- remember tomato and tomato products contain benzoates
What is an exclusion diet
- remove all dietary triggers from diet
- 100% compliance 3 months
- can re-introduce slowly after and monitor for recurrance to identify exact triggers
What are the medical therapies that specialists may prescribe
- topical tx
- intralesional steroid injection
- systemic tx to modulate immune system
What is the topical tx for OFG
- miconazole for angular cheilitis
- tacrolimus ointment for lip swelling and facial erythema
What is intralesional steroid injection
- injected into area of swelling
- usually weekly for 3 wks
- usually needs repeated every 6 months
